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Why Fever is Your Friend

By Rachel Olis

Many parents have experienced waking in the middle of the night to find your child flushed, hot, and sweaty. Your little one’s forehead feels warm. You immediately suspect a fever, but are unsure of what to do next. Should you get out the thermometer? Call the doctor? Visit an emergency room?

Fever occurs when the body’s internal “thermostat” raises the body temperature above its normal level. This thermostat is found in the part of the brain called the hypothalamus. to keep it that way.

In kids, fevers usually don’t indicate anything serious. Although it can be frightening when your child’s temperature rises, fever itself causes no harm and can actually be a good thing — it’s often the body’s way of fighting infections. And not all fevers need to be treated. High fever, however, can make a child uncomfortable and worsen problems such as dehydration.

“Fevers are the number one reason parents bring their child to the emergency room,” said Dr. Mark Baker, an Emergency Medicine Physician at Children’s of Alabama and Assistant Professor at UAB. “They account for 20 percent of all patient visits, and typically, can be treated at home.”

So how should you treat your child’s fever? When is it appropriate to seek medical attention? Here are three recommendations:

1 – Simply Monitor Your Child at Home

Kids whose temperatures are lower than 102°F (38.9°C) often don’t require medication unless they’re uncomfortable. There’s one important exception to this rule: If you have an infant 3 months or younger with a rectal temperature of 100.4°F (38°C) or higher, call your doctor or go to the emergency department immediately. Even a slight fever can be a sign of a potentially serious infection in young infants, Baker said or some other attribution needed.
The illness is probably not serious if your child:

  • is still interested in playing
  • is eating and drinking well
  • is alert and smiling at you
  • has a normal skin color
  • looks well when his or her temperature comes down

And don’t worry too much about a child with a fever who doesn’t want to eat. This is common with infections that cause fever. For kids who still drink and urinate normally, not eating as much as usual is okay.

2 – Contact your physician or visit and Emergency Room

In the past, doctors advised treating a fever on the basis of temperature alone. But now they recommend considering both the temperature and a child’s overall condition.

If your child is between 3 months and 3 years old and has a fever of 102.2°F (39°C) or higher, call your doctor to see if he or she needs to see your child. For older kids, take behavior and activity level into account. Watching how your child behaves will give you a pretty good idea of whether a minor illness is the cause or if your child should be seen by a doctor, says Baker.

Sometimes kids with fever breathe faster and may have a higher heart rate. You should call the doctor if your child is having difficulty breathing, is breathing faster than normal, or continues to breathe fast after the fever comes down.

The exact temperature that should trigger a call to the doctor depends on the age of the child, the illness, and whether there are other symptoms with the fever.

Call your doctor if you have an:

  • infant younger than 3 months old with a rectal temperature of 100.4°F (38°C) or higher
  • older child with a temperature of higher than 102.2°F (39°C)

Call the doctor if an older child has a fever of less than 102.2°F (39°C) but also:

  • refuses fluids or seems too ill to drink adequately
  • has persistent diarrhea or repeated vomiting
  • has any signs of dehydration (urinating less than usual, not having tears when crying, less alert and less active than usual)
  • has a specific complaint (e.g., sore throat or earache)
  • still has a fever after 24 hours (in kids younger than 2 years) or 72 hours (in kids 2 years or older)
  • has recurrent fevers, even if they only last a few hours each night
  • has a chronic medical problem such as heart disease, cancer, lupus, or sickle cell anemia
  • has a rash
  • has pain with urination

3 – Visit an Emergency Room

Seek emergency care if your child shows any of these signs:

  • inconsolable crying
  • extreme irritability
  • lethargy and difficulty waking
  • rash or purple spots that look like bruises on the skin (that were not there before the child got sick)
  • blue lips, tongue, or nails
  • infant’s soft spot on the head seems to be bulging outward or sunken inwards
  • stiff neck
  • severe headache
  • limpness or refusal to move
  • difficulty breathing that doesn’t get better when the nose is cleared
  • leaning forward and drooling
  • seizure
  • abdominal pain

Also, ask your doctor for his or her specific guidelines on when to call about a fever.

Keeping Kids Academically Active During Summer Break

By Rachel Olis

Going back to school isn’t always easy after a summer of relaxation and fun. Getting back into the habits of going to bed early and doing homework can be difficult. However, there are many ways that children can continue learning over the summer, and the transition back into “school mode” can be much more seamless.

“Playing is learning. Activities such as going to the zoo and museums, cooking, crafting and reading can all help children use the skills they already have to continue learning throughout the summer,” said Tara Motte, a teacher in Children’s Sunshine School.

The Sunshine School is a program at Children’s that helps patients stay on top of their schooling. It is staffed by six Alabama state certified teachers who all have the same goal of ensuring children stay educated and reach their highest learning potential despite their circumstances.

Even though students in the Sunshine School may continue their school work throughout the summer, it is important to keep all children’s minds active even when on summer break.

Fortunately, there are many ways to incorporate learning into everyday play time:

  • Take trips to the zoo, museums and library.
  • Use math skills by cooking and baking.
  • Do a science experiment.
  • On rainy days, use play dough to craft animals or make secondary colors.
  • Use some downtime each day to read for at least 15 to 30 minutes.
  • Limit screen time, including television, to an hour and a half and go outside instead!

Summer is also a time for travel and vacations, so use car rides as an opportunity to learn.

  • Use a standard deck of cards to play simple games like Go Fish and Crazy Eights, or even pack a set of trivia cards.
  • Give each child a journal and have them write down what they see along the way.
  • Play the Alphabet Game- pick any topic of interest and take turns naming something within that topic starting with the letter A, and so on.
  • Bring a large map and have the kids highlight and sticker all the different roads you take.
  • Have the children read. Bring the audio version as well so they can read along or listen if they get car sick.

The summer provides many opportunities for families to spend time together and have fun! However, it is important to ensure that children are keeping active physically and mentally throughout those weeks off.

Children’s expanding, improving services for children treated for cleft palates and lips

Dr. John GrantBy Dr. John Grant

During my first year at UAB and Children’s Hospital about 16 years ago, I performed about a half dozen operations to correct cleft lips and a couple of surgeries to correct cleft palates. Last year—along with my partner, Dr. Peter D. Ray—our team performed about 200 operations. This phenomenal growth in our clinic has been accompanied by improved quality.

We use advanced techniques along with a comprehensive team approach that provides care well beyond the operating room. For example, within the past decade, pediatric plastic surgeons have learned to correct underlying muscles in cleft lips and palates, thus providing a much more natural look and better speech for our patients. The face is dynamic, and these new techniques lead to a broader range of facial expressions and better speech control. Of course, we usually work with young patients, but there is an enormous opportunity to improve outcomes for older children and even adults who underwent cleft surgeries before these new techniques were widely used.

Due to our growth, Children’s now houses one of the nation’s busiest clinics for treating cleft lips and palates. We add about 150 new patients annually, and follow them through adolescence. We are excited about our upcoming move into larger quarters. The area that previously housed the emergency department in Children’s McWane Building has been renovated and will nearly double our space. We hope this makes us more efficient and enables us to shorten waits in our clinic for children and their families.

We already offer a full-service program that is staffed with experienced health care professionals, such as audiologists, speech-language pathologists and registered nurses as well as specialized physicians and dentists. They’ve seen hundreds of patients, and there’s a cumulative knowledge base. Our staff has realistic expectations about how children heal, how much pain they may or may not have and airway issues for babies versus adults.

We are excited about the launch of our new international fellowship program. For many years, American doctors have traveled to developing countries where they quickly perform operations for cleft palates and lips. Unfortunately, there is often a lack of follow-up care, and many patients go untreated. We want to educate doctors from these countries so they can establish their own full-service clinics that will provide more thorough and consistent care. The first fellow will be coming this summer from Ghana, West Africa, for 11 months of training, and another will come next year from Egypt. We are hopeful that they will become the teachers for the next generation of doctors in their countries and make it possible for children in those places to have full-time, quality follow-up and coherent planning, instead of care based on chance.

Additionally, we are improving our techniques for conditions other than cleft lips and palates. One service line we want to increase is a technique called tissue expansion. It’s been used a lot in secondary burn reconstruction. But we are also using it for children with giant congenital nevus, or dark patches of skin, often on the face or scalp. We surgically place flat balloons under adjacent, normal skin, and families are taught to slowly inflate these balloons over weeks so a child’s skin is stretched. Then, the patient returns to the hospital for an operation that utilizes the stretched skin to replace discolored skin, restoring normal tissue. We have enhanced this service line with the help of Dr. Bruce S. Bauer of Chicago, a pediatric plastic surgeon who is renowned for his refinement and application of this technique. It’s low risk for the patient and requires little time in the hospital.

All this work is extremely rewarding for our team. Seeing families get their babies back after a cleft operation is an occasion that many parents tell us is nearly as joyful as giving birth.

 

Preventing noise-induced hearing loss

By Rachel Olis

Loud volumes on iPods, cell phones and other personal devices are contributing to an increase in the number of children, teens and adults that suffer from noise-induced hearing loss (NIHL) each year. Hearing loss is the third most common health problem in the United States and affects over 36 million Americans.

“Hearing loss in children has become a serious problem,” said Heather Baty, audiologist at Children’s of Alabama. “It is critical to a child’s safety and to the development of many social skills, speech and learning.”

According to the American Speech, Language and Hearing Association, almost 12 percent of all children between the ages of 6-9 have noise-induced hearing loss (NIHL).

Part of the inner ear, called the cochlea, contains tiny hair cells that send sound messages to the brain. However, once the hair cells within the cochlea are damaged, they cannot grow back, making the damage permanent. A hearing test is often necessary to detect NIHL because many people are not aware of the loss. Children rarely complain about the symptoms of NIHL which include distorted and muffled sounds that make understanding speech more difficult.

Fortunately, noise-induced hearing loss is 100 percent preventable. Here are some ways to prevent NIHL:

  • Turn it down- a very simple way to prevent NIHL is to turn down the volume on iPods, cell phones, the television and the radio. Keep the volume at no more than 60 percent, or at normal conversation volume. Also, being able to hear music outside of the headphones is a sure sign that the volume is too loud and hearing is being affected!
  • Limit listening time- another easy way to prevent NIHL is to limit the amount of time with ear buds in. A good rule is the 60percent/60-minute rule. Keep the volume at 60 percent for no more than 60 minutes.
  • Use hearing protection- ear muffs are often less damaging than ear buds, but both can be dangerous when not used in moderation. Fortunately, both are available with features that promote safe hearing. Also, wear earplugs at concerts and places where the noise will be damaging.

April is National Child Abuse Awareness Month

By Rachel Olis

Child abuse is more than bruises and broken bones. While physical abuse might be most visible, other types of abuse, such as emotional abuse or child neglect, also leave deep, long lasting scars. Some signs of child abuse are subtler than others. Since April is National Child Abuse Awareness Month, the experts at Children’s of Alabama want to remind you of the importance of recognizing and reporting abuse of any kind.

“By learning common types of abuse and what you can do, you can make a huge difference in a child’s life,” says Deb Schneider, director of Children’s Hospital Intervention and Prevention Services, or the CHIPS Center at Children’s of Alabama. “The earlier abused children get help, the greater chance they have to heal from their abuse and not perpetuate the cycle.”

The four types of child abuse are:
• Physical Abuse
• Sexual Abuse
• Emotional Abuse
• Neglect

In Alabama, one in six kids are physically abused every year and as many as 25 percent of children will be sexually abused by the time they reach age 18. Physical abuse is the leading cause of death under the age of 3.

Neglect remains the highest reported form of abuse in our state.

The signs of child abuse vary depending on the type of abuse, but there are some common indicators:

Warning signs of emotional abuse in children:
• Excessively withdrawn, fearful or anxious about doing something wrong.
• Shows extremes in behavior (extremely compliant or extremely demanding; extremely passive or extremely aggressive).
• Doesn’t seem to be attached to the parent or caregiver.
• Acts either inappropriately adult (taking care of other children) or inappropriately infantile (rocking, thumb-sucking, tantrums).
Warning signs of physical abuse in children:
• Frequent injuries or unexplained bruises, welts, or cuts.
• Is always watchful and “on alert,” as if waiting for something bad to happen.
• Injuries appear to have a pattern such as marks from a hand or belt.
• Shies away from touch, flinches at sudden movements, or seems afraid to go home.
• Wears inappropriate clothing to cover up injuries, such as long-sleeved shirts on hot days.

Warning signs of neglect in children:
• Clothes are ill-fitting, filthy, or inappropriate for the weather.
• Hygiene is consistently bad (unbathed, matted and unwashed hair, noticeable body odor).
• Untreated illnesses and physical injuries.
• Is frequently unsupervised or left alone or allowed to play in unsafe situations and environments.
• Is frequently late or missing from school. Read more

National Poison Prevention Week: Danger of Disc Batteries

disc_batteriesBy: Ann Slattery, DrPH, RN, RPh, CSPI, DABAT, Managing Director, Regional Poison Control Center at Children’s of Alabama

There are many objects throughout a household that children can swallow, but one particular object that has warranted many calls to the Regional Poison Control Center at Children’s of Alabama (RPCC) are disc batteries, which can easily be mistaken for a quarter or other coins. The RPCC at Children’s of Alabama has received 60 exposure calls related to disc batteries in the last three years with no fatalities.

Disc batteries are round flat batteries that range in size from a pencil eraser to a quarter (5 mm – 20 mm) that are used in watches, calculators and hearing aids. The majority of exposures to disc batteries occur in curious children.

From 1985-2009, 56,535 disc battery ingestions were reported to the National Poison Data System. Fortunately, deaths after swallowing a disc battery are rare, less than 0.02 percent. However, these ingestions are serious, so it is important to be aware of the symptoms of possible poisoning. These symptoms include cough, wheezing, irritability, poor appetite, vomiting, lethargy, fever and dehydration.

More often than not, the caregiver did not see the ingestion of the disc battery, but if a disc battery is swallowed, an X-ray is needed to find its location in the body. Only then can appropriate recommendations be made.

  • If the battery has moved beyond the esophagus, most will pass uneventfully through the rest of the digestive system and pass within a matter of few days.
  • If the battery is lodged in the esophagus, it is considered an emergency and requires immediate removal.
  • A disc battery becoming lodged beyond the esophagus is unlikely, but if it happens, burns may occur resulting in tissue damage and internal bleeding, causing in a medical emergency.

The majority of disc battery ingestions occur immediately after the battery is removed from the object, but discarded or loose batteries also account for a fair amount of ingestions. It is very important to keep disc batteries out of reach and out of sight!

National Poison Prevention Week is March 16 – 22, 2014. The themes are “Children Act Fast…So Do poisons!” and “Poisoning Spans a Lifetime.” While pediatric (less than 6 years of age) exposures account for 52 percent of The Regional Poison Control Centers (RPCC) at Children’s of Alabama human exposures; adults also experience poisoning with adult exposures accounting for 32 percent of the call volume.  The RPCC received 37,842 calls in 2013 including more than 24, 000 human exposures with more than 44,000 follow up calls. In 2014 the RPCC expects to receive 58,000 calls with 38,000 human exposures. The RPCC is available 24/7 at 1-800-222-1222.

Too Much Screen Time?

By: Rachel Olis

Children growing up today spend more time with technology than any previous generation. Unfortunately, this also means that they spend more time sitting in front of a screen. But at what point have the kids had too much? From tablets and cell phones to TV’s and laptops, children have a lot of opportunity for screen time. Although there are educational programs and apps, the negative effects of having too much media exposure seem to outweigh the positive.

“On average kids spend about seven hours a day on media, but we’d really prefer to see kids playing,” said Dr. Dan Marullo, pediatric neuropsychologist at Children’s of Alabama.

The American Academy of Pediatrics (AAP) recommends that children under the age of 2 not watch any television and that older kids have no more than two hours of screen time per day.

“If you are starting to see your child not spending as much time interacting with other families or friends, not playing, not engaging in favorite activities, research shows that there can be a link between too much media exposure and obesity and hypertension,” he said.

Problems paying attention and concentrating, depression or anxiety, and even aggression can also be signs that your child has had too much media exposure.

Here are a few ways to limit children’s screen time:

  • Limit the number of screen time hours.
  • When a program is over, turn the television off instead of surfing the channels.
  • Set up a “media free zone” that includes bedrooms and the kitchen during dinner.
  • Make a screen time schedule that all members of the family abide by.
  • Make watching television a family affair.
  • Set a good example. Put down your cell phone and exchange watching television for something active.

Fortunately, there are many alternatives to the screen. Here are some examples:

  • Send your kids outside to play, or go play with them!
  • Involve them in a sport such as baseball, ballet, lacrosse or swimming.
  • Have a family game night – play board games and cards.
  • Sit down and read together.

The amount of fun activities you and your kids can do without the TV and tablets are endless. For more information on how to have healthy screen time habits, visit http://www.childrensal.org.

Medical specialists at Children’s of Alabama use teamwork and technology for cardiovascular care

By Yung Lau, MD

Dr. Yung LauChildren’s of Alabama recently marked one year since pediatric cardiovascular services moved into the new Joseph S. Bruno Pediatric Heart Center from University of Alabama Hospitals. This move has markedly improved the scope and delivery of care. The program has been the primary referral point for patients with pediatric and congenital heart disease from throughout the state but the move has allowed us to progress quickly to advance the care of our patients further and more completely.

Two elements have contributed to this progress: Our technology and our team.

Our new facility provides one of the best platforms for care in the world. We have the latest equipment in the right configuration. First, the Bruno Heart Center is really a heart hospital within a hospital — located on the entire fourth floor of the Benjamin Russell Hospital for Children.

The center includes a 20-bed intensive care unit, a 16-bed telemetry ward, two dedicated cardiovascular surgical suites, two catheterization labs; one of which is a “hybrid” room where a patient can undergo surgery and catheterization simultaneously. The intensive care unit has four rooms dedicated to extracorporeal membrane oxygenation (ECMO), which is similar to the heart bypass process often used during cardiac surgery.

Having all these facilities and equipment located on one floor is critical for the care and comfort of our cardiovascular patients. Operating rooms are near catheterization labs. And they are on the same floor as the hybrid room and the ICU. So children who are on many intravenous medications and even on ECMO can be moved among any of these rooms without ever having to switch floors. That is really, really huge. Our intensive care unit used to be housed in a large, single room. Now, there are private rooms with space for parents to stay while their child is hospitalized.

While the facilities are world-class, we are just as proud of the multispecialty, multidisciplinary team that has been assembled to deliver comprehensive care. Cardiologists, surgeons, intensivists and anesthesiologists all work together. It’s not just in name only. Every one of those specialties is dedicated solely to the care of children with heart disease. I don’t know if there is any other field where there is such a close alliance and such teamwork among so many different specialties.

Keeping Your Child’s Teeth Healthy

By Rachel Olis

When should I schedule my child’s first trip to the dentist? Should my 3-year-old be flossing? How do I know if my child needs braces?

Many parents have a tough time judging how much dental care their kids need. They know they want to prevent cavities, but they don’t always know the best way to do so.

When Should Dental Care Start?
Proper dental care begins even before a baby’s first tooth appears. Remember that just because you can’t see the teeth doesn’t mean they arent there. Teeth actually begin to form in the second trimester of pregnancy. At birth, your baby has 20 primary teeth, some of which are fully developed in the jaw.

Running a damp washcloth over your baby’s gums following feedings can prevent buildup of damaging bacteria. Once your child has a few teeth showing, you can brush them with a soft child’s toothbrush or rub them with gauze at the end of the day.

Parents and childcare providers should help young kids set specific times for drinking each day because sucking on a bottle throughout the day can be equally damaging to young teeth.

Pediatric Dentists
Consider taking your child to a dentist who specializes in treating kids. Pediatric dentists are trained to handle the wide range of issues associated with kids’ dental health. They also know when to refer you to a different type of specialist such as an orthodontist to correct an overbite or an oral surgeon for jaw realignment.

A pediatric dentist’s primary goals are prevention -heading off potential problems before they occur, and maintenance- using routine checkups and proper daily care to keep teeth and gums healthy.

The American Dental Association (ADA) and the experts at Children’s recommend that a child’s first visit to the dentist take place by their first birthday. At this visit, the dentist will explain proper brushing and flossing techniques (you need to floss once your baby has two teeth that touch) and conduct a modified exam while your baby sits on your lap.

Such visits can help in the early detection of potential problems, and help kids become accustomed to visiting the dentist so they’ll have less fear about going as they grow older.

Brushing at least twice a day and routine flossing will help maintain a healthy mouth. Kids as young as age 2 or 3 can begin to use toothpaste when brushing, as long as they’re supervised. Kids should not ingest large amounts of toothpaste.

If Your Child Has a Problem
If you are prone to tooth decay or gum disease, your kids may be at higher risk as well. Therefore, sometimes even the most diligent brushing and flossing will not prevent a cavity. Be sure to call your dentist if your child complains of tooth pain, which could be a sign of a cavity that needs treatment.

To schedule a visit with the Dental Clinic at Children’s, please call 205-638-9161.

Dr. Sri Explains It All: When to Worry About a Fever

By Dr. Sri Narayanan

Fevers can be scary. Your child has all the energy knocked out of him, he’s panting and sweaty and clammy and fussy all at the safeverme time. As dangerous as they may seem, fevers are simply the body’s way to rev up the immune system and kill the viruses or bacteria that are causing an infection – with the side effect of making you feel lousy. Thankfully, most children with fevers have viruses that just need to run their course, and they can be managed at home without needing to see a doctor for further testing.

Most doctors define fever as a temperature over 100.4 degrees Fahrenheit (38 degrees Celsius), measured rectally in infants and under the armpit or tongue in older children. We see a lot of kids in the Emergency Department for fever, and our advice is usually the same:

  • Give them plenty of fluids
  • Let them rest
  • Try some acetaminophen or ibuprofen if they cannot get comfortable

Here are a couple of situations where you may want to seek medical attention:

  • Fever in an infant under 2 months of age. Little babies with a cold start off the same way as little babies with severe infections, so we recommend that any infant under 2 months with a fever gets an evaluation in the Emergency Department.
  • Fever for more than five days. Some viruses like influenza and EBV (the virus that causes mono) can cause fever for a week, but an illness that lasts this long is unusual enough that you should see your pediatrician.
  • Fever and vomiting / abdominal pain. If the pain is bad enough that the usual over-the-counter medicine is not helping, or if your child cannot even keep down sips of fluids, they are at high risk for dehydration and should be seen by a physician.
  • Fever and difficulty breathing. As I wrote about in last month’s blog post, bronchiolitis season is here, and we saw several kids with the flu. Rapid breathing or pulling in at the neck/ribs is a reason to get checked out sooner rather than later.

Contrary to what you may hear, fevers do not cause brain damage, no matter how high the temperature gets. In a small percentage of kids under age six, fevers can cause seizures, but these almost always stop on their own and have no long-term effects. If your child is seen in our Emergency Department for a febrile seizure, we have an informative video all about seizure facts and first aid.

Fevers are a natural part of healing and are the sign of a strong immune system. They can certainly be uncomfortable, but they are rarely dangerous. Follow the tips above to help your child recover as quickly as possible, and to know when it’s important to seek medical attention.

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